Provider Demographics
NPI:1699138735
Name:RAGOTHAMAN, KEVIN
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:RAGOTHAMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10353 TORRE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3217
Mailing Address - Country:US
Mailing Address - Phone:408-358-6234
Mailing Address - Fax:408-358-3389
Practice Address - Street 1:10353 TORRE AVE STE C
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3217
Practice Address - Country:US
Practice Address - Phone:408-358-6234
Practice Address - Fax:202-362-3330
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5606213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist